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underweight kid


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Has 5 years experience.

Age is important here. I remember when I was younger, I was the epitome of scrawny...and I'm STILL much skinnier than I'd like to be (current BMI as underweight...I hate my metabolism). Really does depend on the child, but talking to the parents might be all it takes. If there's any indication of abuse, you'd see it when meeting with the parents (i.e. noticeable fear of parents, changed character when around them, etc). :)


Specializes in ER volunteer.

interesting how everyone immediately either gets ***** off or wants to know if there's other signs of abuse... but you're forgetting about another big weight factor - eating disorders. that's something that the kid could be very good at hiding from his/her parents, so they might not know about, and a notification home could allow them to get their child help while it's still early enough to make a difference. Eating disorders are a lot easier treated when they've only been going on for a few months then when they've been part of your life for years...

Edited by JustBeachyNurse

And what if the child was being neglected?

I don't understand why a parent would be mad?!?!

I suppose it would depend on the tone of the phone call/letter - as in an "FYI" or an "accusatory" sort of way...I can relate - my girl twin is also just over 10th percentile - up until she was 5 she wasn't ON the chart - her pedi never worried, she followed her own growth curve and never dropped/fell off it...

All just opinions here...I think we are on the same page, OP. If you perform a nursing assessment, the rest of the nursing process needs to follow. To screen and not intervene if there are abnormal results would be pointless and not in the kid's best interest. From my perspective, referral to a healthcare provider for further evaluation is an appropriate next step if the weight is out of normal range. I wonder why your employer doesn't have guidelines for referral & follow-up spelled out somewhere???

It seems like a lot of responses are from a parent's perspective, rather than a nurse's. Those perspectives may help the OP to be more sensitive when approaching the parent & remind her that there are a variety of factors to consider, but it doesn't really give her nursing guidance.

One last thought: "Underweight" means

Simply Complicated

Specializes in Med/Surg, Neuro, ICU, travel RN, Psych. Has 5 years experience.

I agree that I think the tone and how it is approached is what is most important. I have a tiny peanut for a daughter who has not even been on the growth chart. Having personally dealt with both aspects, Dr's who say it's not a problem, to others who made it a big deal, I can understand why some would be upset. I actually switched pediatricians because I got tired of the back and forth. One doctor said it's not a worry, the next appointment we'd see someone else, and I'm told we need to address this issue and it's a big deal. Being told your child is underweight can feel like a personal attack, or that someone is telling you that you are doing something wrong. Maybe because even being told your child is fine, it can still be in the back of your mind that you are not feeding them enough or something.

A phone call over a letter would probably appease me more. It's easier to handle it with less miscommunication. Starting with this is just a protocol, part of our assessment and we are trying to gather all the facts type statement can make a big difference.

About 8 month ago, my daughter was in the hospital overnight with an injury. There was a student nutritionist (didn't know that at the time, as she didn't identify herself) just comes in the room and starts talking. Asking me all these questions because there was "something wrong". She had no clue what she was talking about. Being a nurse, I didn't freak. I actually spoke with the teacher, and they used it as a learning experience. But had I been anyone else, it could have been a bad situation. I could have gotten even more upset, believing there was something wrong with her.


Has 5 years experience.

I wish someone told me i was underweight (fat chance) lol. Tell me i need to eat hahaha....

Again thanks for all your responses... it helps

CrunchRN, ADN, RN

Specializes in Clinical Research, Outpt Women's Health. Has 25 years experience.

My niece at age 9 has developed a full blown eating disorder after the untimely death of her father in February. Along with it comes a lot of hiding and lying around food consumption.

I would very much want the school nurse to call the mom. And i know the mom would tell her she appreciated the input and let her know what is being done to treat this illness and definitely welcome any assistance the school nurse may offer for when the child is at school.

I think any parent that would get upset with the nurse just for checking is really being short sighted. There may be things going on that the parent does not know and to alienate the nurse for being "nosy" is in my opinion ridiculous.

My daughter is 3rd percetile. I'm aware and ped is aware and we're not worried. I wouldn't mind an 'FYI' letter or call AT ALL. We don't do BMI measuring at my school, but I think a letter stating something to the effect of "There may be many reasons for BMI to be outside the norm, but we recommend that talk to your pediatrician if you have not already done so" would be pretty inoffensive.

classicdame, MSN, EdD

Specializes in Hospital Education Coordinator.

have parents considered patient may be undiagnosed Type I diabetic??

BeenThereDoneThat74, MSN, RN

Specializes in Pediatrics. Has 26 years experience.

I'm always surprised (but not really) how PROFESSIONALS here are so defensive about certain things. If this were a plain old parenting board, I wouldn't be surprised at all. But this is a licensed professional with a concern. When we are talking about the lay public, we cannot assume they know everything that we Do, what is WNL, both physically, cognitively, developmentally or behaviorally. I am a Peds nurse, and when my child was in pre-k I got a note home suggesting that I work with my child, regarding zipping her jacket, there was nothing developmentally; just always did it for her! I was not at all offended.

It here could be a million (well, maybe not a million) reasons the weight is below the curve. In clinical, we recently had a teen-age pt who was the size of an 8 year old. He had crohns. Docs told the family he probably had it for about 5 years and didn't know it. obviously if he was the size of an 8 year old, he's been below the curve for years. Bt let's throw stones at the school nurse, because its not her business to observe and act on a normal finding... Until the parents are looking for a lawsuit. And they pull the school records and see that he's been weighed and measured every year and no one did anything.

As a society, we need to get over ourselves, and not be so suspicious and defensive.


Has 4 years experience.

"There may be many reasons for BMI to be outside the norm, but we recommend that talk to your pediatrician if you have not already done so" would be pretty inoffensive.

I think this part is important and may "soften the blow" so to speak. Even our vision/hearing screening referral letters say something to the effect of "this is only a screening and does not necessarily mean there is a problem."

I'm also wondering if in the OP this was part of a yearly screening. If so, was this different from last year? If the child is routinely in the lower percentile it may be the child's norm but if the child suddenly started losing weight then there may be more to it. I know that for some reason our PE teacher is required to do a height and weight in gym class, but I do not do one in the clinic. If I had a student I was worried about I might be able to check with her as well.

mustlovepoodles, RN

Specializes in OB/GYN, Peds, School Nurse, DD.

dear school nurses,

im new to school nursing and have a question and hope i can get some answers please. a teacher brought down a kid to me who is 37lbs and has a BMI of 14.6. now this is in the 5th percentile which means the kid is underweight. now will u handle this situation. call the parents, send a letter home? what? any info is very much appreciated

If the kid weighs 37-lbs and has a BMI of 14'.6, he would have to be 3"6", right? I dont' think that is terrible, if he is very young. I have a couple of kindergarten kids at school who probably are this small. Their parents are aware and they are being followed by their doctor. I think my oldest son was probably close to this BMI.


Specializes in ICU, OR. Has 12 years experience.

I am sure the parents already know. Do they go to the pediatrician for well visits? They get weighed there too. My kid was way below the percentile chart for years. Was on meds for acid reflux. Then at age 3 decided it's just a case of being petite. And a picky eater. There's not much I can do as a parent. Unless this family is extremely uneducated and poor, they are well aware of their child's weight. Maybe if this is an area where you think the family does not go to a pediatrician once a year, and really needs an intervention as far as feeding them, then maybe give them a call. But as a parent of an underweight child, there is no need to. Would I be mad if you called me? No, I would understand that you are concerned. But don't be surprised if the parent says yes, I know, and there is nothing we can do about it.